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14. Exercise counselling and referral in cancer care: an international scoping survey of health care practitioners’ knowledge, practices, barriers, and facilitators

Author

Ramsey, Imogen, Chan, Alexandre, Charalambous, Andreas, Cheung, Yin Ting, Darling, HS, Eng, Lawson, Grech, Lisa, Hart, Nicolas H, Kirk, Deborah, Mitchell, Sandra A, Poprawski, Dagmara, Rammant, Elke, Fitch, Margaret I, and Chan, Raymond J more...

Subjects
Clinical Trials and Supportive Activities, Rehabilitation, Behavioral and Social Science, Clinical Research, Cancer, Prevention, Health Services, 7.1 Individual care needs, Health and social care services research, 8.1 Organisation and delivery of services, Management of diseases and conditions, Humans, Surveys and Questionnaires, Referral and Consultation, Exercise, Attitude of Health Personnel, Counseling, Neoplasms, Cancer survivors, Education, Guidelines, Physical activity, Knowledge translation, Medical and Health Sciences, Psychology and Cognitive Sciences, Oncology & Carcinogenesis
Abstract

PurposeEvidence supports the role of prescribed exercise for cancer survivors, yet few are advised to exercise by a healthcare practitioner (HCP). We sought to investigate the gap between HCPs' knowledge and practice from an international perspective.MethodsAn online questionnaire was administered to HCPs working in cancer care between February 2020 and February 2021. The questionnaire assessed knowledge, beliefs, and practices regarding exercise counselling and referral of cancer survivors to exercise programs.ResultsThe questionnaire was completed by 375 participants classified as medical practitioners (42%), nurses (28%), exercise specialists (14%), and non-exercise allied health practitioners (16%). Between 35 and 50% of participants self-reported poor knowledge of when, how, and which cancer survivors to refer to exercise programs or professionals, and how to counsel based on exercise guidelines. Commonly reported barriers to exercise counselling were safety concerns, time constraints, cancer survivors being told to rest by friends and family, and not knowing how to screen people for suitability to exercise (40-48%). Multivariable logistic regression models including age, gender, practitioner group, leisure-time physical activity, and recall of guidelines found significant effects for providing specific exercise advice (χ2(7) = 117.31, p more...

Published
2022

15. Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives

Author

Joseph, Ria, Hart, Nicolas H, Bradford, Natalie, Agbejule, Oluwaseyifunmi Andi, Koczwara, Bogda, Chan, Alexandre, Wallen, Matthew P, and Chan, Raymond J

Subjects
Health Services and Systems, Nursing, Health Sciences, Prevention, Cancer, Nutrition, 8.1 Organisation and delivery of services, 7.3 Management and decision making, Management of diseases and conditions, Health and social care services research, Cancer Survivors, Diet, Exercise, Health Personnel, Humans, Neoplasms, Referral and Consultation, Health personnel, Cancer survivor, Attitude, Role, Physical activity, Medical and Health Sciences, Psychology and Cognitive Sciences, Oncology & Carcinogenesis, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

PurposeTo examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals.MethodsAn integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators.ResultsTwenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice.ConclusionAlthough medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals. more...

Published
2022

17. Supportive care 2030 movement: towards unifying ambitions for global excellence in supportive cancer care—an international Delphi study

Author

Chan, Raymond Javan, Knowles, Reegan, Ashbury, Fredrick D., Bowen, Joanne, Chan, Alexandre, Chin, Melissa, Olver, Ian, Taylor, Carolyn, Tinianov, Stacey, Alberti, Paola, Bossi, Paolo, Brito-Dellan, Norman, Cooksley, Tim, Crawford, Gregory Brian, Dixit, Niharika, Fitch, Margaret I., Freedman, Jason L., Ginex, Pamela K., Hart, Nicolas H., Hertz, Daniel L., Jefford, Michael, Koczwara, Bogda, Naito, Tateaki, Orsey, Andrea Dahlman, Ruhlmann, Christina H., Tsoukalas, Nikolaos, van den Hurk, Corina, Van Sebille, Ysabella, Wardill, Hannah Rose, Scotte, Florian, and Lustberg, Maryam more...

Published
2024
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19. Dual contribution of the gut microbiome to immunotherapy efficacy and toxicity: supportive care implications and recommendations

Author

Wardill, Hannah R, Chan, Raymond J, Chan, Alexandre, Keefe, Dorothy, Costello, Samuel P, and Hart, Nicolas H

Subjects
Immunization, Vaccine Related, Clinical Research, Development of treatments and therapeutic interventions, 5.1 Pharmaceuticals, Cancer, Good Health and Well Being, Gastrointestinal Microbiome, Humans, Immunologic Factors, Immunotherapy, Neoplasms, Quality of Life, Immune checkpoint inhibitors, Efficacy, Toxicity, Adverse events, Gut microbiome, Supportive cancer care, Medical and Health Sciences, Psychology and Cognitive Sciences, Oncology & Carcinogenesis
Abstract

The efficacy of immune checkpoint inhibitors (immunotherapy) is increasingly recognized to be linked to the composition the gut microbiome. Given the high rates of resistance, interventions targeting the gut microbiome are now being investigated for its ability to improve the efficacy of immunotherapy. In light of recently published data demonstrating a strong correlation between the efficacy and toxicity of immunotherapy, there is a risk that efforts to enhance immunotherapy efficacy may be undermined by increases in immune-related adverse events (IrAEs) This is particularly important for microbial interventions aimed at increasing immunotherapy efficacy, with many microbes implicated in tumour response also linked to IrAEs, especially colitis. IrAEs have a profound impact on patient quality of life, causing physical, psychosocial, and financial distress. Here, we outline strategies at the discovery, translational, and clinical research phases to ensure the impact of augmenting immunotherapy efficacy is approached in a manner that considers adverse implications. Adopting these strategies will ensure that our ongoing efforts to overcome immunotherapy resistance are not impacted by unacceptable toxicity. more...

Published
2022

22. Barriers and facilitators to exercise among adult cancer survivors in Singapore

Author

Chan, Alexandre, Ports, Kayleen, Neo, Patricia, Ramalingam, Mothi Babu, Lim, Ang Tee, Tan, Benedict, Hart, Nicolas H, Chan, Raymond J, and Loh, Kiley

Subjects
Health Services and Systems, Nursing, Health Sciences, Pediatric, Rehabilitation, Prevention, Cancer, Clinical Research, Behavioral and Social Science, Pediatric Cancer, Digestive Diseases, Management of diseases and conditions, 7.1 Individual care needs, Good Health and Well Being, Adult, Breast Neoplasms, Cancer Survivors, Cross-Sectional Studies, Exercise, Female, Humans, Quality of Life, Retrospective Studies, Singapore, Oncology, Cancer survivorship, Counseling, Barriers, Facilitators, Medical and Health Sciences, Psychology and Cognitive Sciences, Oncology & Carcinogenesis, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

PurposeExercise can help cancer survivors manage sequela, treatment side effects, improve overall quality of life, and is recommended for most. The purpose of this study was to investigate exercise behavior and factors influencing exercise engagement among cancer survivors at the National Cancer Centre, Singapore (NCCS).MethodsThis cross-sectional study was inclusive of survivors of all cancer types and stages who were at least 21 years of age and had undergone chemotherapy at the NCCS. Surveys were utilized to assess survivor barriers and facilitators to exercise and to retrospectively assess physical activity and exercise behaviors at 4 cancer-related time periods (pre-diagnosis and post-diagnosis before, during, or after chemotherapy).ResultsA total of 102 cancer survivors were enrolled; 60% were diagnosed with stage IV cancer. Predominant cancer types included lower gastrointestinal tract (25.5%) and breast cancer (21.6%). Prior to cancer diagnosis, 90.2% of participants reported aerobic activity satisfying NCCN guidelines. Significant reductions in reported exercise, and physical activity, were observed following cancer diagnosis that persisted during chemotherapy. Key exercise facilitators included the desire to remain healthy (86.3%) and to improve sleep and mental well-being (73.5%). Key barriers included side effects of treatment (52.0%). Only 46.1% of survivors reported receiving exercise guidance from healthcare professionals following diagnosis.ConclusionOverall, even among this notably active cohort of Singaporean survivors, opportunities for increased exercise engagement throughout the survivorship continuum remain. Increased education regarding the benefits of exercise to survivors as well as guidance regarding exercise modalities including resistance training is greatly needed as well. more...

Published
2022

43. Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol.

Author

Newton, Robert U, Kenfield, Stacey A, Hart, Nicolas H, Chan, June M, Courneya, Kerry S, Catto, James, Finn, Stephen P, Greenwood, Rosemary, Hughes, Daniel C, Mucci, Lorelei, Plymate, Stephen R, Praet, Stephan FE, Guinan, Emer M, Van Blarigan, Erin L, Casey, Orla, Buzza, Mark, Gledhill, Sam, Zhang, Li, Galvão, Daniel A, Ryan, Charles J, and Saad, Fred more...

Subjects
Humans, Disease Progression, Phenylthiohydantoin, Androstenes, Androgen Antagonists, Receptors, Androgen, Exercise Therapy, Quality of Life, United States, Male, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Clinical Trials, Phase III as Topic, Prostatic Neoplasms, Castration-Resistant, disease progression, immune function, inflammation, physical activity, tumour biology, Receptors, Androgen, Clinical Trials, Phase III as Topic, Prostatic Neoplasms, Castration-Resistant, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionPreliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).Methods and analysisParticipants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.Ethics and disseminationValidation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.Trial registration numberNCT02730338. more...

Published
2018

45. Essential elements of optimal dietary and exercise referral practices for cancer survivors: expert consensus for medical and nursing health professionals

Author

Joseph, Ria, Hart, Nicolas H., Bradford, Natalie, Wallen, Matthew P., Han, Chad Y., Pinkham, Elizabeth P., Hanley, Brigid, Lock, Gemma, Wyld, David, Wishart, Laurelie, Koczwara, Bogda, Chan, Alexandre, Agbejule, Oluwaseyifunmi Andi, Crichton, Megan, Teleni, Laisa, Holland, Justin J., Edmiston, Kelli, Naumann, Leonie, Brown, Teresa, and Chan, Raymond J. more...

Published
2023
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